After You Apply
Six things to do once you are enrolled, so your plan takes effect, stays in force, and does what you expect when you use it.
Enrolling Is Not the Last Step
Six things need to happen after you apply, so that your plan takes effect, stays in force, and does what you expect when you use it.
Today's health plans put a great deal of responsibility on the member. Networks are narrower than they used to be, almost every transaction happens on the insurance company website, and a small administrative miss can turn into a large bill or a canceled policy.
Nearly every claims and billing problem we help clients untangle traces back to one of these six steps being skipped. Work through them in order. Most take a few minutes each, and they only have to be done once.
The Six Steps
Each step has its own page. Follow them in order, or click straight to the one you need.
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Pay your initial or binder premium. Your plan does not go into effect until the first month's premium has been paid. This is the most urgent item on the list.
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Sign up for auto pay. Being canceled for non payment can leave you uninsured until the next open enrollment. Automating the premium removes that risk.
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Set up a username and password. The single most important thing you can do to use your plan well. Essentially all health insurance business is now done online.
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Read your policy. The Evidence of Coverage tells you what is covered and what you pay. Find your deductible, your out of pocket maximum, and your copays.
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Verify your providers are in network. Confirm each doctor, lab, imaging center, and hospital is contracted on your specific plan. This check saves the most money.
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Access your claims information and EOBs. Learn where your claims and Explanations of Benefits live before you need them. This is where every billing question gets answered.
Ongoing best practices
The six steps are one time setup. These are the habits that keep a plan working well year after year.
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Check the formulary before you fill a new prescription, so you know which tier it falls in and what it will cost. If it is not on the list, ask your doctor about a formulary alternative, or have the doctor request prior authorization.
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Re-verify your doctors each year at renewal. Networks change, and a provider who was in network last year may not be this year.
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Tell Covered California, or tell us, when your income or household size changes, so a subsidy stays accurate and there is no surprise at tax time.
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Keep your insurance card and your login where you can find them, and take the card to every appointment.
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Call us first when a claim is denied or a bill looks wrong. That is what an agent is for, and it costs you nothing.
It bears repeating
The number one best practice for using your health plan effectively is to set up a username and password on your insurance company website. Everything else on this page gets easier once that is done.
Something Not Working Right?
Claims problem, surprise bill, or a website you cannot get into? Call us. We are your advocate and there is no charge for the help.